Rubber band ligation is widely used in medicine to entrap tissue in order to obliterate tissue or occlude blood vessels. Such applications consist of the utilization of “rubber bands” to strangulate and necrose tissue, such as internal hemorrhoids.
The principle of the rubber band ligator is well-known. In fact, the original hemorrhoidal ligating instrument (the Barron's bander) is still widely-used today. Although rubber band ligators are practical for treating hemorrhoids, most rubber band ligators can only hold and place one rubber band at a time. The Barons bander is a typical, “single shot” device and, thus, necessitates reloading of the instrument for application of each rubber band. Reloading the ligator is a time consuming and frustrating task which must occur while the patient is in an uncomfortable position. Thus, a major disadvantage of the typical ligator is the difficulty encountered in reloading the rubber bands.
In order to reduce the number of reloadings necessary during a hemorroidectomy, some ligator devices are configured to store and dispense a number of rubber bands. For example, in U.S. Pat. No. 6,136,009 to Mears, a ligating band dispenser is disclosed which stores multiple rubber bands and dispenses a single band at a time from a storage position to a release position (see FIG. 1). However, like many other devices intended to store and release multiple bands, the ligating band dispenser of the type taught by Mears can be bulky, difficult to hold and use particularly in conjunction with other instruments, difficult to position accurately, have an abundance of moving parts related to dispensing of bands, and have only a limited amount of space for storage of bands. Furthermore, if more rubber bands are needed than are preloaded on the Mears-type device, then the device must be retracted, reloaded and reinserted. These actions are likely to cause discomfort to the patient and may compromise the sterility of the procedure. Such factors tend to increase the complexity, cost, and size of the ligator devices and to decrease the reliability, reusability and maneuverability of the ligator devices.
Conventionally, anoscopes have hollow cylindrical configurations and allow only limited access and viewing of internal hemorrhoid areas. For instance, as shown in U.S. Pat. No. 4,834,067 to Block, many anoscopes have only a single lateral aperture to provide exposure to a single internal hemorrhoid. As such, in order to gain access to and apply a rubber band to multiple internal hemorrhoids, the operator is required to retract and reinsert the anoscope multiple times. Some anoscopes are constructed of clear material to increase visibility, while some are configured with a plurality of apertures so as to attempt to provide better access to hemorrhoid areas. For example, in U.S. Pat. No. 6,126,594 to Bayer, an anoscope is provided which has a plurality of annularly spaced apertures that allow simultaneous access to multiple hemorrhoid areas (see FIG. 2). Although Bayer may reduce the number of times that insertion of the anoscope is required, the plurality of apertures in this type of anoscope must be aligned so as to properly expose the hemorrhoids, and if adjustment is required for access to an internal hemorrhoid, unnecessary discomfort may result.
Thus, a heretofore unaddressed need exists in the industry to address the aforementioned deficiencies and inadequacies and to provide a ligator and anoscope system that provides access to the locations of multiple internal hemorrhoids and simultaneously supplies multiple rubber bands for ligation of multiple hemorrhoids without necessitating multiple retractions and reinsertions of the ligator and anoscope.